Apparatus and method for sculpting the surface of a joint

• US 6,482,209 B1
• Filed: 06/14/2001
• Issued: 11/19/2002
• Est. Priority Date: 06/14/2001
• Status: Expired due to Term

• Current Assignee: Cayenne Medical Incorporated (Zimmer Biomet Holdings, Inc.)
• Original Assignee: Alexandria Research Technologies, LLC
• Inventors: Engh, Gerard A., Johnson, Wesley D.
• Primary Examiner(s): Philogene, Pedro
• Application Number:
  US09/882,591
• Time in Patent Office: 523 Days
• Field of Search: 606/79, 606/80, 606/82, 606/83, 606/170, 606/176, 606/177, 606/179, 606/180, 606/88, 606/86, 623/20.21, 623/20.32, 623/20.35, 623/20.14, 623/20.15
• US Class Current: 606/79
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/0206 with antagonistic arms as supports for retractor elements
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/1628 Motors; Power supplies
• CPC Class Codes: A61B 17/1631 Special drive shafts, e.g. flexible shafts A61B17/1642, A61B17/164 take precedence
• CPC Class Codes: A61B 17/1666 for the acetabulum
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/32002 with continuously rotating, oscillating or reciprocating cutting instruments
• CPC Class Codes: A61B 2017/00398 using powered actuators, e.g. stepper motors, solenoids
• CPC Class Codes: A61B 2017/00539 hydraulically
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0268 for the knee
• CPC Class Codes: A61B 2017/0275 for the hip
• CPC Class Codes: A61B 2017/1602 Mills
• CPC Class Codes: A61F 2/30724 Spacers for centering an implant in a bone cavity, e.g. in a cement-receiving cavity
• CPC Class Codes: A61F 2/30767 Special external or bone-contacting surface, e.g. coating for improving bone ingrowth
• CPC Class Codes: A61F 2/30942 for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques
• CPC Class Codes: A61F 2/34 Acetabular cups
• CPC Class Codes: A61F 2/3662 Femoral shafts
• CPC Class Codes: A61F 2/38 for elbows or knees
• CPC Class Codes: A61F 2/3859 : Femoral components
• CPC Class Codes: A61F 2/3872 : Meniscus for implantation between the natural bone surfaces
• CPC Class Codes: A61F 2/3877 : Patellae or trochleae
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2/4603 : for insertion or extraction of endoprosthetic joints or of accessories thereof
• CPC Class Codes: A61F 2/461 : of knees
• CPC Class Codes: A61F 2/4684 : Trial or dummy prostheses
• CPC Class Codes: A61F 2002/30092 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2002/30604 : modular
• CPC Class Codes: A61F 2002/30616 : Sets comprising a plurality of prosthetic parts of different sizes or orientations
• CPC Class Codes: A61F 2002/30884 : Fins or wings, e.g. longitudinal wings for preventing rotation within the bone cavity
• CPC Class Codes: A61F 2002/30894 : inclined obliquely with respect to each other
• CPC Class Codes: A61F 2002/3895 : unicompartimental
• CPC Class Codes: A61F 2002/4631 : the prosthesis being specially adapted for being cemented
• CPC Class Codes: A61F 2002/4635 : using minimally invasive surgery
• CPC Class Codes: A61F 2002/4681 : by applying mechanical shocks, e.g. by hammering
• CPC Class Codes: A61F 2002/4693 : hydraulic
• CPC Class Codes: A61F 2002/4694 : pneumatic
• CPC Class Codes: A61F 2210/0014 : using shape memory or superelastic materials, e.g. nitinol
• CPC Class Codes: A61F 2310/00017 : Iron- or Fe-based alloys, e.g. stainless steel
• CPC Class Codes: A61F 2310/00023 : Titanium or titanium-based alloys, e.g. Ti-Ni alloys
• CPC Class Codes: A61F 2310/00029 : Cobalt-based alloys, e.g. Co-Cr alloys or Vitallium
• CPC Class Codes: A61F 2310/00952 : Coating, pre-coating or prosthesis-covering structure made of bone cement, e.g. pre-applied PMMA cement mantle

Abstract

The present invention provides a method and device for restoring individual patient joint kinematics using minimally invasive surgical procedures. The instrumentation of the invention sculpts the articular surface of a first bone that normally articulates in a predetermined manner with a second bone. The instrumentation includes a bone sculpting tool and a mount for attaching the tool to the second bone. The implant system is comprised of implants that provide intraoperative surgical options for articular constraint and facilitate proper alignment and orientation of the joint to restore kinematics as defined by the individual patient anatomy.

Claims

1. An apparatus for sculpting the articular surface of a first bone that normally articulates in a predetermined manner with a second bone, the apparatus comprising:

a bone-sculpting tool;

a mount attachable to the second bone for mounting the tool in position to sculpt the articular surface as the second bone is articulated in the predetermined manner with respect to the first bone.

2. The apparatus of claim 1 wherein the mount is configures for rigid attachment to the second bone.

3. The apparatus of claim 1 wherein the mount is integral to the bone-sculpting tool.

4. The apparatus of claim 1 wherein the mount is an external fixture.

5. The apparatus of claim 1 wherein

the bone-sculpting tool includes a bone-sculpting surface generally symmetrical about an axis of rotation of the tool, and wherein

the tool is positioned with respect to the articular surface to be sculpted with the axis of rotation generally parallel to an articular plane defined by normal articulation of one of the bones with respect to the other.

6. The apparatus of claim 5 wherein:

the bone-sculpting surface includes one or more milling burrs wherein the milling burr or burrs have an axis of rotation generally oriented in an anterior to posterior direction.

7. The apparatus of claim 6 including an inside burr, an outside burr, and a middle burr, the middle burr having a larger radius than the inside and outside burrs.

8. The apparatus of claim 6 wherein the burr or burrs are contoured to provide a cutting surface that is convex to the axis of rotation.

9. The apparatus of claim 5 wherein the bone-sculpting surface is generally cylindrical in shape.

10. The apparatus of claim 1 wherein

the bone-sculpting tool includes a bone-sculpting surface generally symmetrical about an axis of rotation of the tool, and wherein

the tool is positioned with respect to the articular surface to be sculpted with said axis of rotation generally perpendicular to an articular plane defined by normal articulation of one of the bones with respect to the other.

11. The apparatus of claim 10 wherein:

the bone-sculpting surface includes one or more milling burrs wherein the milling burr or burrs have an axis of rotation generally oriented in a medial to lateral direction.

12. The apparatus of claim 11 including an inside burr, an outside burr, and a middle burr, the middle burr having a larger radius than the inside and outside burrs.

13. The apparatus of claim 11 wherein the burr or burrs are contoured to provide a cutting surface that is convex to the axis of rotation.

14. The apparatus of claim 11 wherein the burr or burrs are contoured to provide a cutting surface that is concave to the axis of rotation.

15. The apparatus of claim 10 wherein the bone-sculpting surface is generally cylindrical in shape to produce a sculpted groove having a floor that is curved in said articular plane but that is generally straight in a t′

direction perpendicular to the plane.

16. The apparatus of claim 1 further including a distractor configured for insertion between the first and second bones for distracting the first bone from the second bone while allowing normal articulation between the first and second bones.

17. The apparatus of claim 16 wherein the distracter is a fixed thickness spacer.

18. The apparatus of claim 16 wherein the distractor includes surfaces engagable with the respective bones, and means enabling adjustment of the distances between the surfaces.

19. The apparatus of claim 18 wherein the distracter is a fluid filled catheter or balloon.

20. The apparatus of claim 18 wherein the distracter is a mechanical wedge.

21. The apparatus of claim 1 wherein the mount further comprises a positioning element for positioning the bone-sculpting tool at variable elevations along a superior-inferior axis such that the bone-sculpting tool depth in the first bone during articulation may be adjusted.

22. The apparatus of claim 21 wherein the mount further include shoulders having skid-surfaces thereon.

23. The apparatus of claim 21 wherein the positioning element provides an adjustable distraction between the first bone and the second bone.

24. The apparatus of claim 1 further comprising a motor for driving the bone-sculpting tool.

25. The apparatus of claim 24 wherein the motor is a hydraulic motor having vanes for driving the hydraulic motor in response to hydraulic fluid flow against the vanes.

26. The apparatus of claim 25 wherein the vanes of the hydraulic motor extend radially from the axis of rotation of the bone sculpting tool.

27. An apparatus for sculpting the articular surface of a first bone that normally articulates in a predetermined manner with a second bone, the apparatus comprising:

a plurality of bone-sculpting tools; and

one or more mounts attachable to the second bone for mounting the tools in position to sculpt the articular surface as the second bone is articulated in the predetermined manner with respect to the first bone.

28. Method of sculpting the articular surface of a first bone that normally articulates with a second bone, comprising:

a) providing a bone-sculpting tool and a mount,

b) attaching the mount to the second bone with the tool in bone-sculpting engagement with the articular surface of the first bone, and

c) sculpting the articular surface of the first bone by articulating one of the bones with respect to the other.

29. Method of sculpting the articular surface of a first bone that normally articulates in a predetermined manner with a second bone, comprising:

a) providing a bone-sculpting tool and a mount, and an adjustable attachment for attaching the bone sculpting tool to the mount;

b) attaching the mount to said second bone; and

d) sculpting the articular surface of the first bone by articulating one of the bones with respect to the other.

30. The method of claim 29 including the step of distracting the first bone from the second bone preoperatively to assess the range of motion of the second bone to the first bone and patient kinematics.

31. The method of claim 29 including the step of distracting the first bone from the second bone during sculpting of the first bone.

32. The method of claim 31 wherein the first bone is distracted from the second bone allowing the second bone to hang freely from soft tissue attachments to the first bone during the sculpting procedure.

33. The method of claim 31 further including the step of providing a distractor, and distracting the first bone from the second bone with the distractor.

34. The method of claim 33 wherein the distractor is expandable, the method including the step of expanding the tensioning device.

35. The method of claim 33 wherein the distractor is integral to the bone sculpting tool to distract the first bone from the second bone during the sculpting procedure.

36. A method of sculpting the articular surface of a first bone that articulates with a second bone, comprising attaching a bone-sculpting tool to the second bone with the tool in sculpting proximity to the articular surface of the first bone, and sculpting said articular surface by articulating the bones.